Long‐term efficacy of endoscopic ligation plus cyanoacrylate injection with or without sclerotherapy for variceal bleeding

Abstract

No superiority of combined ligation and sclerotherapy compared with continued ligation and cyanoacrylate injection for secondary prophylaxis of variceal bleeding is observed.

A novel CT-guided technique using medical adhesive for localization of small pulmonary ground-glass nodules and mixed ground-glass nodules (≤20 mm) before video-assisted thoracoscopic surgery

“…It rapidly creates a thin elastic film of high tensile strength in the presence of anions in the blood, with a reticular structure that ensures firm adherence to tissues. It is applied not only to vascular embolization in digestive tract endoscopy treatment, interventional radiology and neuroradiology, but also to achieve hemostasis of diffuse bleeding in internal organs (3). The necessity, benefits and risks of preoperative localization procedure using the adhesive was explained to every patient.…”

Favorable Effects of Endoscopic Ligation Combined with Drugs on Rebleeding and Mortality in Cirrhotic Patients: A Network Meta-Analysis

“…On the other hand, sclerotherapy was significantly associated with more adverse events and serious adverse events than vasoactive drugs (vasopressin, terlipressin, somatostatin, or octreotide) [52]. In a recent study, however, no superiority of combined ligation and sclerotherapy over continued ligation and cyanoacrylate injection for secondary prophylaxis of variceal bleeding was observed [53]. These side effects or lack of added benefits with sclerotherapy might partly explain why EIS alone ranks so low with regard to the treatment efficacies, and why it is not recommended for secondary prophylaxis in AASLD guideline [44].…”

Comparison of the effectiveness of 11 mainstay treatments for secondary prophylaxis of variceal bleeding in patients with cirrhosis: A network meta‑analysis

“…Only one trial declared early cessation (54). A total of two trials were open labelled (20,24) and two trials reported using outcome assessors under blinded conditions (27,16). Blinding of the remaining trials was not specified.…”

“…According to the newly published guidelines of the American Association for the Study of Liver Diseases (AASLD) and consensus (14), therapies for secondary prophylaxis must account for the presence or absence of other complications of cirrhosis. In patients with a low risk of death (those with variceal haemorrhage as the sole complication of cirrhosis), the objective of therapy should be the prevention of an additional complication, whereas in patients with a high risk of death (those with variceal haemorrhage and other decompensating events), the objective of therapy should be to improve survival (15,16). Mortality (overall mortality, mortality due to rebleeding and mortality due to liver failure), treatment failure and complications (bleeding from gastroesophageal ulcer) were analyzed.…”